BRFBs, also known as body-focused repetitive behaviors, fall under the Obsessive-Compulsive and Related Disorders section of the DSM-5-TR. Although hair-pulling and skin-picking can affect just about anyone, they are often associated with eating disorders. So it is worth exploring how and why BFRBs align with eating disorders.
By: Regina Colie
Skin-picking is not uncommon. The urge one has to tear skin off a finger happens without even taking a second to reconsider. However, the intensity of skin-picking can progress and become a concern. Body-focused repetitive behaviors are “intense urges like biting, picking, and pulling that can cause damage.” (Bhandari, 2020). While there are similarities to obsessive-compulsive disorder (OCD), the two are not entirely connected. The two most common disorders featured within the Diagnostic and Statistical Manual of Mental Disorders are trichotillomania and excoriation. While there are various reasons why individuals engage in these behaviors, there are, unfortunately, several reasons why these behaviors initiate while one is struggling with an eating disorder.
Trichotillomania and Excoriation
Trichotillomania, also known as a hair-pulling disorder, is characterized in the DSM as an individual pulling out one’s hair constantly, resulting in hair loss. “Hair pulling may occur from any region of the body in which hair grows; the most common sites are the scalp, eyebrows, and eyelids.” (DSM-5-TR, 2022). The disorder is seen as self-induced and can continue for months to years, depending on the severity of one’s symptoms. There is no known cause, but the disorder can stem from genetic and environmental factors (Eating Disorder Hope).
Excoriation, also known as skin picking disorder, is characterized in the DSM as an individual engaging in recurrent picking of one’s skin that results in lesions. “The most commonly picked sites are the face, arms, and hands, but many individuals pick from multiple body sites.” (DSM-5-TR, 2022). Like trichotillomania, there are no known causes but can stem from environmental or genetic factors. The connection between these two behaviors and eating disorders is that they can derive from obsessive compulsiveness. “Men or women who are struggling with an eating disorder may feel corresponding urges or compulsions to pull out their hair or only feel momentary replied from tension when hair is pulled.” (Eating Disorder Hope). For someone struggling with an eating disorder, there is a sense of feeling overwhelmed or unhappy connected to a person’s appearance or eating habits. Engaging in these physical behaviors can give the person a distorted sense of relief from the pressure cooker of tension. Both of these disorders are associated with negative emotions and a need to stay in control of compulsivity. Moreover, these severe disorders affect both men and women and require appropriate and effective treatment to improve an individual’s physical and mental health.
Seeking Treatment
Treatment can be utilized simultaneously because of the universal similarities with these disorders. Cognitive-behavioral therapy (CBT) is recommended in helping to reduce these compulsive behaviors. This is because CBT supports a person in developing other coping strategies to combat stress and anxiety rather than using harmful physical ones.
Medications can also be prescribed to help alleviate symptoms but should only be advised under the recommendation and supervision of a primary care physician or psychiatrist. In addition, eating disorder specialists should be included within the treatment team to help discuss the issues surrounding eating habits, along with establishing a more recovery-aligned mindset.
At BALANCE eating disorder treatment center™, our compassionate, highly skilled team of clinicians is trained in diagnosing and treating the spectrum of eating disorders, including anorexia, bulimia, binge eating disorder, compulsive overeating, and other disordered eating and body image issues. Additionally, BALANCE offers free virtual support groups open to individuals seeking help and family and loved ones. The group provides a supportive forum within which members can explore issues, including ambivalence about engaging in treatment, recovery, resources, and treatment options and knowing when and how to take the next steps toward making change. RSVP for our next group on Saturday, October 8th, at 11:00 am EST here.
BALANCE also now offers exclusive insurance trials in its virtual track. With our insurance trials, eligible participants get access to treatment right away, comprehensive payment options, and our team’s support in navigating your coverage. Your insurance could cover up to 80% of your allowed amount up front, reducing the cost of your treatment, and allowing you to pay the remaining balance through a payment plan, after an initial deposit. Reach out here to see if you qualify.
This post was written by BALANCE Blog Contributor, Regina Colie (she/her).
Regina Colie is currently pursuing her Masters in General Psychology at The New School For Social Research. She is interested in working with women who have eating disorders and postpartum depression. Upon her graduation from Marymount Manhattan College, she had the opportunity to be published in Dr. Nava Silton’s book, The Impact of the COVID-19 Pandemic on Child, Adolescent, and Adult Development. Her previous work has been featured in Project HEAL, BALANCE, Olive Branch Nutrition, and Nourishing NY.
References
Picking, Pulling, Biting: Body Damaging Disorders with Pictures. (n.d.). WebMD. Retrieved April 18, 2022, from https://www.webmd.com/mental-health/ss/slideshow-understanding-body-focused-repetitive-behavior
Eating Disorder Hope. (2014, February 5). Eating Disorders and Trichotillomania Hair-Pulling Co-Occurring. Retrieved April 18, 2022, from https://www.eatingdisorderhope.com/treatment-for-eating-disorders/co-occurring-dual-diagnosis/trichotillomania
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders. Van Haren Publishing.
